Stress urinary incontinence (SUI) affects primarily women, but also men, and is generally caused by two conditions, intrinsic sphincter deficiency (ISD) and hypermobility. These conditions may occur independently or in combination. In ISD, the urinary sphincter valve, located within the urethra, fails to close properly (coapt), causing urine to leak out of the urethra during stressful activity. Hypermobility is a condition in which the pelvis floor is distended, weakened or damaged, causing the bladder neck and proximal urethra to rotate and descend in response to increases in intra-abdominal pressure (e.g., due to sneezing, coughing, straining, etc.). As a result, the patient's response time becomes insufficient to promote urethral closure and, consequently, the patient suffers from urine leakage and/or flow.
A popular treatment of SUI uses a surgical sling placed under the bladder neck or the mid-urethra to provide a urethral platform. Placement of the sling limits the endopelvis fascia drop. The sling can be affixed using a bone anchoring method or by an anchorless approach.
Another proposed treatment uses energy delivered to the patients' own pelvic support to selectively contract or shrink at least a portion of the pelvic support tissue, thereby raising the position of the bladder. However, the reported outcome for treatment of urinary incontinence with RF energy alone has indicated statistically disappointing or inconclusive success rates.
Accordingly, there is still a need for an improved approach for supporting the urethra to treat SUI and/or for providing support to other fascia, tendons, and other support tissues which have been strained, or which are otherwise too long to provide the desired support.